Reliability and Clinical Relevance of the HIV-1 Drug Resistance Test in Patients With Low Viremia Levels

Abstract

In patients failing cART with LLV, HIV-1 genotyping provides reliable and reproducible results that are informative about emerging drug resistance.

Strengthening HIV therapy and care in rural Tanzania affects rates of viral suppression

“…29 Although this observation should be interpreted cautiously owing to our reported few cases with viral load ,500 copies/mL, these findings are consistent with previous studies in sub-Saharan Africa and support the WHO threshold used for defining virological failure. 30 Our findings are in agreement with the WHO recommendations for HIV viral load testing in resource-limited settings, which suggest that patients with low viraemia should undergo intensified adherence interventions to regain HIV-1 RNA suppression without switching ART, 31 and those with repeated high viral load measures should be switched to second-line ART without delay. 32,33 Interestingly, we did not detect the K65R mutation, which reduces the susceptibility to tenofovir disoproxil fumarate, despite the fact that one-third of patients with detectable HIV-DRM had been on a tenofovir-based regimen for a minimum of 6 months.…”

Low-level viraemia, measured as viraemia copy-years, as a prognostic factor for medium–long-term all-cause mortality: a MASTER cohort study

“…30,31 In contrast, other studies reported a correlation between persistent low-level viraemia and virological failure with detection of drug resistance. 6,32,33 A recent study shows that long episodes of pVL fluctuating at 50 copies/mL under boosted PI-based regimens rarely result in drug resistance or virological failure. 34 The CASCADE study on HIV seroconverters showed a stronger benefit of cART in patients with higher VCY before initiating treatment as regards the risk of AIDS or death occurrence.…”

Efficacy of genotypic drug resistance testing in patients with low-level plasma HIV-1 viremia

“…HIV-1 genotyping at LLV has been proven both reliable and valuable [15] and may guide antiretroviral treatment modification [16]. It was reported, that genotype based treatment optimization allowed to achieve virologic suppression in the 90.2% of patients with the history of low-level viremia [10].…”